Key result
Right bundle branch block pattern on surface electrocardiogram after right ventricular pacing can be a variant of normal uncomplicated pacing and does not necessarily indicate lead malposition.
Case Report (n=1)
No
An RBBB pattern during RV apical pacing may be a normal variant, and multimodality assessment can prevent unnecessary interventions for suspected lead malposition.
RBBB pattern after RV pacing may not indicate malposition, warranting multimodality confirmation before revision; leaves open prospective validation before practice change.
RBBB pattern on surface electrocardiogram after right ventricular pacing is always concerning for lead malposition in left ventricle. However it can be a variant of normal pacing and careful assessment with chest X-ray, 2 D ECHO and ECG reassures normal pacing and can prevent unnecessary interventions.
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Ritin Bomb (2014) conducted a case report in Atrio-ventricular conduction abnormality (n=1). Right ventricular apical pacing was evaluated on ECG morphology and lead placement confirmation. Right bundle branch block pattern on surface electrocardiogram after right ventricular pacing can be a variant of normal uncomplicated pacing and does not necessarily indicate lead malposition.
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